DHECA score: A decision-making score to identify the need for CPAP treatment beyond the apnea-hypopnea index

Abstract

Purpose: Obstructive sleep apnea (OSA) is a highly prevalent condition. Continuous positive airway pressure (CPAP) is the preferred treatment for a significant number of patients, but there is no established consensus among various guidelines or recommendations regarding its indication. This study reports on the level of agreement among an international Spanish-speaking group of OSA experts to create a consensus score that will facilitate the simple identification of CPAP indications for patients with OSA.

Methods: Thirty-three sleep medicine specialists from various countries analyzed the criteria for CPAP indication in patients with OSA. The discussion was conducted virtually and asynchronously using the Delphi method. Four rounds of questions were carried out to score different aspects relating the severity of OSA to associated disorders that showed correction or improvement with CPAP use. The rounds of consultation concluded when consensus was reached on the score required for CPAP indication. Subsequently, an analysis was performed comparing the application of the score to usual clinical practice in two reference university hospitals.

Results: This consensus study has led to the development of a simple and practical score for determining CPAP indication in patients with OSA. The score was tested and compared against real-world clinical practice in two reference university hospitals.

Conclusions: We believe that the developed score facilitates the easy identification of patients who should receive CPAP and standardizes criteria for comparing therapeutic outcomes across different patient series with this condition.

Keywords: CPAP indication; Delphi method; Obstructive sleep apnea (OSA).